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Full name(s) :
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__________________________________________________________________________ |
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Surname :
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__________________________________________________________________________ |
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Name known by :
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__________________________________________________________________________ |
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Wife's name
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__________________________________________________________________________ |
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Residential address :
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__________________________________________________________________________ |
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__________________________________________________________________________ |
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__________________________________________________________________________ |
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______________________________________________________
Code : _____________ |
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Postal address :
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__________________________________________________________________________ |
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__________________________________________________________________________ |
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__________________________________________________________________________ |
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__________________________________________________________________________ |
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______________________________________________________
Code : _____________ |
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Phone numbers :
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Home |
(_______) |
____________________________ |
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Work |
(_______) |
____________________________ |
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Cell |
(_______) |
____________________________ |
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E-mail address :
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__________________________________________________________________________ |
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Date of birth :
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______________________________ |
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Company and profession :
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______________________________ |
Profession :
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__________________________ |
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Military service record
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Regiment/Unit qualified :
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______________________________ |
Date :
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__________________________ |
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Regiments served under :
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__________________________________________________________________________ |
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Proof of qualification (Log book/ Jump cert./etc)
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______________________________________________________ |
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(attach copy)
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Introduced by :
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______________________________ |
Approved by :
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__________________________ |
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Verified by :
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______________________________ |
Approved by :
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__________________________ |
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Date approved :
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______________________________ |
Membership no :
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__________________________ |
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Declaration: APPLICANT HEREBY ACCEPTS MEMBERSHIP
IF SUCCESSFULLY APPROVED, AND AGREES TO
ABIDE BY THE CONSTITUTION OF THE LEGION
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Applicant's signature :
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______________________________ |
Date :
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Membership fee :
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R 40-00 |
Receipt no. :
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__________________________ |
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Subscription fee :
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R 60-00 Annually |
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Stores :
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R 100-00 |
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TOTAL :
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R 200-00 |
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Signature :
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Pay master
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